Surgery for Pancreatic Carcinoma: State of the Art

Shrikhande, Shailesh V.; Barreto, Savio George

doi:10.1007/s12262-011-0373-8

Cited by 13 publications

(6 citation statements)

References 79 publications

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“…However, these trials did not report how many eligible patients were fit enough to be randomized to receive adjuvant chemotherapy. Currently, the strongest predictors of survival include surgery with curative intent, early‐stage disease and complete (R0) resection. None of these predictors are influenced by adjuvant treatment.…”

Section: Introductionmentioning

confidence: 99%

Meta-analysis comparing upfront surgery with neoadjuvant treatment in patients with resectable or borderline resectable pancreatic cancer

Versteijne¹,

Vogel

Besselink

et al. 2018

British Journal of Surgery

417

354

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BackgroundStudies comparing upfront surgery with neoadjuvant treatment in pancreatic cancer may report only patients who underwent resection and so survival will be skewed. The aim of this study was to report survival by intention to treat in a comparison of upfront surgery versus neoadjuvant treatment in resectable or borderline resectable pancreatic cancer.MethodsMEDLINE, Embase and the Cochrane Library were searched for studies reporting median overall survival by intention to treat in patients with resectable or borderline resectable pancreatic cancer treated with or without neoadjuvant treatment. Secondary outcomes included overall and R0 resection rate, pathological lymph node rate, reasons for unresectability and toxicity of neoadjuvant treatment.ResultsIn total, 38 studies were included with 3484 patients, of whom 1738 (49·9 per cent) had neoadjuvant treatment. The weighted median overall survival by intention to treat was 18·8 months for neoadjuvant treatment and 14·8 months for upfront surgery; the difference was larger among patients whose tumours were resected (26·1 versus 15·0 months respectively). The overall resection rate was lower with neoadjuvant treatment than with upfront surgery (66·0 versus 81·3 per cent; P < 0·001), but the R0 rate was higher (86·8 (95 per cent c.i. 84·6 to 88·7) versus 66·9 (64·2 to 69·6) per cent; P < 0·001). Reported by intention to treat, the R0 rates were 58·0 and 54·9 per cent respectively (P = 0·088). The pathological lymph node rate was 43·8 per cent after neoadjuvant therapy and 64·8 per cent in the upfront surgery group (P < 0·001). Toxicity of at least grade III was reported in up to 64 per cent of the patients.ConclusionNeoadjuvant treatment appears to improve overall survival by intention to treat, despite lower overall resection rates for resectable or borderline resectable pancreatic cancer.PROSPERO registration number: CRD42016049374.

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Section: Introductionmentioning

confidence: 99%

Meta-analysis comparing upfront surgery with neoadjuvant treatment in patients with resectable or borderline resectable pancreatic cancer

Versteijne¹,

Vogel

Besselink

et al. 2018

British Journal of Surgery

417

354

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“…Pancreatoduodenectomy (PD), or the Whipple’s operation, is associated with major morbidity and even the risk of mortality [1]. One of the most commonly reported complications of PD is surgical site infections (SSIs).…”

Section: Introductionmentioning

confidence: 99%

Determinants of Surgical Site Infections Following Pancreatoduodenectomy

et al. 2015

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“…Indications for adjuvant chemotherapy include margin‐positive disease or nodal positivity. For locally advanced tumors, chemoradiotherapy in a neoadjuvant setting is being used extensively [33]. A recent meta‐analysis reported improved 12‐month survival in patients who received postoperative gemcitabine in combination with radiotherapy [34].…”

Section: Discussionmentioning

confidence: 99%